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Type 1 Diabetes and a Potential Treatment by Immunotherapy

Linda Crampton is an experienced teacher with a first-class honors degree in biology. She writes about the scientific basis of disease.

The pancreas and its internal structure

The pancreas and its internal structure

An Autoimmune Problem

Type 1 diabetes is a major autoimmune disorder that can be managed but not cured. The patient’s immune system attacks the pancreas and stops it from making insulin, a vital hormone. Insulin from another source must be given to the patient in order for them to survive. Although the substitution often works well, it's not a perfect solution for the problem.

In an exciting development, researchers have been able to stop the attack of the immune system in test subjects newly diagnosed with type 1 diabetes, at least during the time frame of the experiment. The process that they’ve discovered may prevent further damage to the pancreas.

The term “immunotherapy” means modifying the action of the immune system is order to treat disease. It’s often used in reference to cancer treatment, which is another exciting application of the therapy. Researchers from King’s College London and Cardiff University have published the results of a clinical trial that shows that the therapy also has potential in the treatment of Type 1 diabetes. The research is still in its early stage but may eventually be very helpful for some cases of the disease.

The creator of the illustration above is a medical doctor, Having one or more of the listed symptoms doesn't necessarily mean that a person has diabetes, however. The person's own doctor should be consulted for a diagnosis and treatment recommendations. Polydipsia is excessive thirst; polyphagia is excessive hunger; polyuria is excessive urine production; and glycosuria is an excessive amount of sugar in the urine.

The Pancreas and Insulin

The pancreas is located in the abdomen behind the stomach. It's a narrow and elongated organ that produces hormones and digestive enzymes. The hormones are produced in structures called pancreatic islets or islets of Langerhans. The structures are shown in the illustration at the start of this article. Insulin is produced by the beta cells in the islets. Once the hormone is made, it's secreted into the bloodstream.

The function of insulin is to control the blood sugar level. Blood "sugar" is actually glucose, a chemical that our cells use for energy production. It's important that the blood sugar level stays relatively constant in order to keep the cells of the body healthy. Both a high and a low blood sugar can be harmful. Insulin stimulates the absorption of glucose by cells.

The acini in the pancreas produce the digestive enzymes. These are secreted into ducts that lead to the small intestine, where digestion of food occurs. The lining of the small intestine also produces enzymes that digest food.

The incidence of type 1 diabetes in Europe has been rising by about 4 per cent each year, particularly in children and teenagers.

— Rachel Baxter, New Scientist

Autoimmunity and Type 1 Diabetes

Our immune system is normally very helpful in our lives. When it's weakened, we have a high risk of getting sick. The system attacks and destroys pathogens (microbes that cause disease), such as bacteria, fungi, and viruses.

In some people, the immune system misbehaves and attacks the body's own cells. This mistake can cause an autoimmune disease—one produced by the person's own immune system instead of by a pathogen. In type 1 diabetes, the immune system attacks the beta cells in the pancreas and destroys them.

The leader of the clinical trial described in this article says that the immune system doesn't destroy all of the beta cells at the same time. People just diagnosed with type 1 diabetes and in the early stage of the disease "typically" have as many as 15% to 20% of their beta cells left. This is a key point in the success of the trial.

Researchers have noticed that the incidence of type 1 diabetes is increasing in several areas. The explanation for this observation is unknown. The disease is most common in children but can occur in people of any age.

Potential Treatment Difficulties

In a healthy pancreas, the amount of insulin that's secreted varies throughout the day (and night). It depends on a variety of factors, including the amount, type, and frequency of food that's eaten and the vigour, length, and frequency of exercise. It's hard to be as precise as the body's natural mechanism for regulating blood sugar when supplemental insulin is used.

A person with diabetes measures their blood sugar level and sends insulin into their body multiple times during a day. Injections or an insulin pump are used to deliver the hormone. Even with treatment, a patient may experience periods when their blood sugar is higher or lower than it should be. Both of these conditions can be harmful to the body if they are extreme or if they are milder but occur frequently or continuously over time. Night time can be especially problematic for a patient.

Improved devices for measuring a patient's blood sugar and injecting insulin are being created. The goal is to create a device that automatically and frequently measures the blood sugar level and then injects the correct amount of insulin or of glucagon, another hormone that influences the amount of glucose in the blood. Glucagon is made by the alpha cells of the pancreatic islets.

An islet of Langerhans (the paler area) in a stained sample

An islet of Langerhans (the paler area) in a stained sample

Possible Disease Complications

Even though insulin treatment may be successful for many years, the patient may eventually develop serious and sometimes life-threatening complications. These complications include eye, nerve, cardiovascular, and kidney problems.

One of my acquaintances developed type 1 diabetes as a child. Sadly, she died in late middle age from complications of the disorder. People with the disease often have an average lifespan of about ten to twelve years shorter than a healthy person. This is an average value, which means that some people live for a longer time and others for a shorter one. We need improved treatments for the disease, or better still, a cure and a way to prevent it.

The Clinical Trial and Its Results

The results of the clinical trial are impressive. The trial was performed by researchers at King's College London and Cardiff University. It involved a relatively small number of people, however. The subjects were adults and had been diagnosed with type 1 diabetes in the last 100 days.

Twenty-one people were periodically injected with a proinsulin peptide. A peptide consists of a short chain of amino acids. The peptide used in the experiment was "proinsulin" because it supports the production of insulin. Its full name is human leukocyte antigen–DR4(DRB1*0401)–restricted immunodominant proinsulin peptide. Eight people in the trial were periodically injected with a saline solution without the peptide. This solution acted as a placebo. A placebo is an inactive and harmless substance.

The injections continued for six months but data was collected from the patients for twelve months. Over the course of the year, the patients given the peptide had no need to increase the amount of insulin that they received. The patients in the placebo group needed to increase the amount of their supplementary insulin by 50%. In addition, the group given the peptide contained roughly the same level of C-peptide in their bloodstream throughout the year. This chemical is used in the production of insulin by the pancreas. In the patients given the placebo, the level of C-protein declined significantly during the year, suggesting that their pancreas was becoming less active.

The administration of the peptide seems to have reset the immune system, stopping its abnormal behaviour and preventing further beta cell destruction. It would be interesting to see the results of an experiment performed with a larger number of people. It would also be interesting to know how long the beneficial effects of the peptide last after injections cease and to discover whether the treatment needs to be repeated at some point.

A colourized scanning electron micrograph of a T cell

A colourized scanning electron micrograph of a T cell

Type 1 diabetes arises due to misbehaving T cells, or T lymphocytes. The cells are a very important and normally very helpful component of the immune system. In type 1 diabetes, however, T cells attack and destroy the beta cells in the pancreas. The proinsulin peptide apparently interferes with the action of the misbehaving T cells.

Double Blind Trials and Placebo Use

The peptide experiment was double blind. In this type of experiment, neither the person administering the treatment nor the subject knows whether the treatment is the one being tested or a placebo. In order for this to work, the test treatment and the placebo must appear to be identical.

A double blind experiment prevents any unconscious influence of the administrator on the results of the experiment. It also prevents any bias in their interpretation of the results. A blind experiment is also important for the subject. A person may feel better if they know that they are being given a treatment because they believe that the treatment will help them. If they don't know whether they are being given the treatment or the placebo, the chance of this effect is reduced.

Placebos are used in experiments even when it's unlikely that simply believing that they will be helped will be beneficial for the patient. A patient may improve during a clinical trial for an unexpected reason, such as the body's natural healing process over time or a factor that the researcher hasn't considered. Comparing the results of a test group and a placebo group can show whether a treatment is helpful or whether an improvement is due solely to another factor. If the subjects in the group that received the treatment show a significantly better result than those in the placebo group, the experiment indicates that the treatment has value.

Clinical Trials Explained

A Potential Problem With Placebos

Clinical trials must be performed before health agencies give permission for a treatment to be prescribed for the general public. Animal tests and tests on isolated human cells are generally performed first to demonstrate the likely effectiveness and safety of the test substance. These tests aren't enough for the regulatory agencies, however. The agencies want to see the results of well-designed clinical trials.

Using a placebo group in a clinical trial is good for demonstrating the effectiveness of a treatment, but it may not be good for the people within the group. If the disease experienced by the subjects is progressive and the test treatment is helpful, those people given the placebo may be at a disadvantage.

The results of the proinsulin peptide experiment were wonderful for the people given the peptide, since their beta cell destruction was halted. The results weren't good for the people who were given the saline solution, since their beta cell destruction continued.

If a researcher decides to use a placebo in a clinical trial, the people who volunteer for the trial know that they may be given the placebo instead of the test treatment. In addition, the researchers don't know for certain whether the test treatment will be effective in humans or exactly how it will affect the body, so there might be a disadvantage to receiving it. Nevertheless, some people consider the use of placebos in certain types of trials to be unethical because the placebo group misses a chance for their disease to be treated.

Additional methods of immunotherapy for type 1 diabetes are currently being investigated, as the last source in the "References" section below describes. Hopefully, one or more of these methods will be useful.

Stem cells may one day be used to treat diabetes.

Stem cells may one day be used to treat diabetes.

The Future for People With Type 1 Diabetes

The peptide research could be very useful for diabetics who still have a significant number of beta cells left. Unfortunately, it may not be applicable to patients who are in this situation today. The researchers think that the new treatment will be ready for general use in five to ten years. In many countries, there are a lot of steps that must be performed before a new medication is approved. Understanding how to reset the immune system in an autoimmune disease could prove to be very important, however.

Stem cell research offers hope for people who have had type 1 diabetes for a long time. Stem cells are unspecialized cells. They have the wonderful ability to produce specific specialized cells under the right conditions. Researchers have been able to produce pancreatic beta cells from stem cells in the lab. It's hoped that eventually it will be possible to produce a large number of beta cells for transplantation into diabetics. Another area of research that could be helpful is the transplant of beta cells from a donor's pancreas into the pancreas of a person with diabetes.

If either of the processes described above happen, it will be important to stop the patient's immune system from attacking the transplanted cells. The results of the peptide research could be very helpful in this respect. When this article was last updated, the research was continuing. I hope it’s very successful.


  • Information about type 1 (and type 2) diabetes from the American Diabetes Association
  • "Pioneering immunotherapy shows promise in type 1 diabetes" from the Medical Xpress news service
  • "Metabolic and immune effects of immunotherapy with proinsulin peptide in human new-onset type 1 diabetes" from Science Translational Medicine (Abstract)

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2017 Linda Crampton


Linda Crampton (author) from British Columbia, Canada on April 25, 2020:

Thanks for the visit and comment, Peggy. I agree with your statement about the clinical trial and COVID-19 volunteers. They are brave people.

Peggy Woods from Houston, Texas on April 25, 2020:

The people who sign up for clinical trials are brave, or in some cases, because nothing else has worked, it is a last resort. I am sorry to hear about your friend, Linda. Diabetes can be a deadly disease that affects so many body parts.

The people who are now volunteering to be test subjects for the possible treatments for COVID-19 fit the brave category. It may or may not help them, but hopefully, it will not harm them, which is a possibility when it comes to potential new treatments.

Linda Crampton (author) from British Columbia, Canada on September 21, 2017:

Thank you very much, Hari. Congratulations on managing your diabetes. Exercise and a healthy diet are always a good idea! Your doctor would be the best person to consult if you have questions. This is especially important if you have type 1 diabetes.

Hari Prasad S from Bangalore on September 21, 2017:

Linda, excellent article. You have shared great research info.

I am diabetic since 17 years. I have been doing exercise daily by going for a 1 hr walk and eat moderately, and my diet is usually millet and wheat based food.

My routine too is more or less maintained without much variation, I feel that this is sufficient to manage diabetes without much complications, However are there any other factors too to consider for managing this deficiency syndrome.

- hari

Linda Crampton (author) from British Columbia, Canada on September 17, 2017:

Thanks for the interesting comment, Anita. I'll have to investigate the properties of mulberry leaves. They sound interesting.

Anita Hasch from Port Elizabeth on September 09, 2017:

Such an interesting hub. Diabetes can cause so much damage to your organs that it is a sickness to avoid if possible. I don't have diabetes but drink mulberry tea as a precaution. Mulberry tea has been used medicinally for thousands of years in China and India. It has an ability to prevent sugars from entering your bloodstream. It also strengthens your blood vessels. I have a tree just outside my door, so I pick the leaves, leave them for a few days to dry, and then make tea from them. Thank you for such an informative hub and images.

Linda Crampton (author) from British Columbia, Canada on September 09, 2017:

Thank you very much for the visit and the comment, DDE.

DDE on September 09, 2017:

Information such as this is important and a must read for everyone.

Linda Crampton (author) from British Columbia, Canada on August 14, 2017:

I'm so sorry that your father lost a leg, Audrey. I hope that you do as well as possible with your diabetes. Best wishes for the future.

Audrey Hunt from Pahrump NV on August 14, 2017:

I have type 2 diabetes and found so much useful information on this hub. My father had type 2 and lost a leg due to ulcers developing in his feet. I remember how I used to clean those sores and then massage his feet afterward to help with circulation. But unfortunately gangrene developed and his entire leg had to be amputated.

Thanks Linda for providing this well researched and informative hub.

Linda Crampton (author) from British Columbia, Canada on August 14, 2017:

Hi, Dora. I appreciate your visit. I'm hoping that a better treatment for diabetes is found, too.

Dora Weithers from The Caribbean on August 14, 2017:

As usual, you article gives much useful information. Thanks for the explanations concerning the causes. Glad for the hope of better treatment for this disease.

Linda Crampton (author) from British Columbia, Canada on August 13, 2017:

Thank you, Genna. I think that stem cell research could offer us wonderful benefits. It's interesting to read about the latest discoveries.

Linda Crampton (author) from British Columbia, Canada on August 13, 2017:

I hope the venture proves fruitful too, Larry. I hope that further research confirms that the treatment is helpful and that it's made available to the public as soon as possible.

Genna East from Massachusetts, USA on August 13, 2017:

I was sorry to learn of what happened to your friend. As always, this article is well-researched and presented in a way we can all understand. I have to agree with the question of placebos in that those receiving it are not being treated for their disease. I am also a strong supporter of stem cell research. Thank you for this very informative hub, Linda.

Larry Rankin from Oklahoma on August 13, 2017:

Such a nasty condition! I sure hope this venture proves fruitful.

Great read!

Linda Crampton (author) from British Columbia, Canada on August 11, 2017:

Hi, Heidi. Thank you very much for the visit and the comment. I hope that immunotherapy is helpful for multiple autoimmune diseases. So many people need help. I hope you have a great weekend as well!

Heidi Thorne from Chicago Area on August 11, 2017:

I'm also hoping the immunotherapy can be a solution for many with autoimmune disorders. I'm most familiar with RA and have seen how it can be life-altering.

Your hubs are so informative and helpful... and this one, hopeful. Thanks, as always, for sharing your knowledge with us! Have a great weekend!

Linda Crampton (author) from British Columbia, Canada on August 11, 2017:

Hi, Jackie. I hope researchers find a way to prevent diabetes, too. I'm glad your blood sugar is staying at a healthy level.

Linda Crampton (author) from British Columbia, Canada on August 11, 2017:

Hi, Martie. I think the human body is fascinating and impressive, but as you say there is a lot that can go wrong with it. Medical research is very important.

Jackie Lynnley from the beautiful south on August 11, 2017:

I agree with those given placebos, I would never volunteer if I had a serious condition.

I have known two people with serious diabetes problems and it is a sad thing. I hope they soon find natural prevention to this disease. Since I have been using mother vinegar and lemon daily I have had no high readings so whether or which one I have no idea but I plan to stick to it.

Martie Coetser from South Africa on August 11, 2017:

The human body - actually all living bodies - is so extremely vulnerable! The merest - even one's own immune system - can attack an organ and destroy its function.

Thanks for this very interesting hub about Type 1 Diabetes, and the new research regarding the production of pancreatic beta cells from stem cells.

Linda Crampton (author) from British Columbia, Canada on August 11, 2017:

Hi, Bill. I appreciate your comment. Your question is interesting! There's a lot to think about with respect to disease and human population.

Bill Holland from Olympia, WA on August 11, 2017:

I'm very sorry, Linda, about your friend. Fascinating article. Give researchers enough time and money and they will manage to cure just about all diseases. Now, for a philosophical discussion, is that good for humanity? Or does it make any difference, since I have no doubt that new diseases will then pop up? I leave those discussions for people wiser than I am.

Linda Crampton (author) from British Columbia, Canada on August 10, 2017:

Thank you very much for the comment and for sharing the information, Flourish. The placebo effect is interesting. I'm sorry that your friend relapsed, though. Cancer is a horrible disease.

FlourishAnyway from USA on August 10, 2017:

I'm sorry about your friend, Linda. This is a very well written and researched article as all of your articles are. Sometimes those placebos can themselves create expectation effects even with physical disease. A family friend was recently in a double blind cancer study and it was halted for her eventually. She had made amazing progress initially and seemed like she had a new lease on life. Months later when she relapsed they took her out of the study and learned it was a placebo all along. I learned a lot from your article. I didn't know adults could come down with Type 1.